Provider Demographics
NPI:1235149279
Name:SCHEIVE, GLENN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:RICHARD
Last Name:SCHEIVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 S BLOOMINGDALE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1400
Mailing Address - Country:US
Mailing Address - Phone:630-893-4530
Mailing Address - Fax:630-893-4584
Practice Address - Street 1:183 S BLOOMINGDALE RD STE 205
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1400
Practice Address - Country:US
Practice Address - Phone:630-893-4530
Practice Address - Fax:630-893-4584
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37930Medicare UPIN
IL695190Medicare ID - Type Unspecified